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Common Health Insurance Questions
How Do I Select A Good Health Plan?
Can the insurance company deny my claim?
Is the tax credit (premium subsidy) still available?
Do I need health insurance to avoid a tax penalty?
What if I miss health insurance open enrollment?
Over half of Americans find it hard to get the information they need to make informed decisions about healthcare coverage.
MrHealthInsurance is a well versed industry expert who knows how health insurance works, and what goes on behind the scenes. If you have a question about your health coverage or other health insurance questions, MrHealthInsurance has the answer!
Sifting through health insurance plans can be very difficult. Most people hope for the best, but don’t understand the rules of today’s health care market. MrHealthInsurance is here to answer health insurance questions and help you make the right decisions for you, your family or your business and it’s employees.
You can sort through pages of information. You can ask your friends for advice. However, when making a decision about something as important as health insurance, why not ask the advice of an expert? For decisions that impact the well-being of your family, or your business and it’s employees, turn to Mr.HealthInsurance!
HOW WELL DO YOU KNOW THE US HEALTHCARE SYSTEM?
We know health insurance in the US can be overwhelming. However, our quiz is easy to understand and will give you some surprising insight into the US healthcare system. Test your knowledge with these important health insurance questions!
How many people in the United States lack health insurance?
A) 19 million B) 33 million C) 24 million D) 42 million
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The information contained on the MrHealthInsurance website is not intended and should not be construed as medical or legal advice. The information should not be used in place of, or in addition to, the advice of health care practitioners, attorneys or tax professionals. If you have a specific question or concern, please contact your regular health care practitioner or legal professional immediately.
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How To Select A Good Health Plan
Consider Services and Costs.
Per the Affordable Care Act, all plans must cover the basic 10 essential healthcare services (see minimum requirements for health plans below). However, in addition to these services, carriers may offer additional coverage. The cost of additional coverage will vary depending on level of services covered and who the carrier is. The Affordable Care Act has also mandated that consumers have a choice between four levels of coverage. Accordingly, Platinum covers 90% of your healthcare costs, Gold which covers 80% of your healthcare costs, Silver covers 70% of your healthcare costs and Bronze covers 60% of your healthcare costs.
Accordingly, as you compare monthly premiums, you should also compare copayments, deductibles, and coinsurance.
Copayments – the fixed dollar amount you must pay for a doctor visit or other covered service. Accordingly, for those individuals who visit the doctor frequently, a plan with a low co-pay may be a good choice.
Deductibles – a deductible is the amount you must pay annually before certain healthcare services will be covered. Accordingly, a high deductible, low premium plan is often a good choice for those individuals who are generally healthy.
Coinsurance – after your deductible is met, you will still pay for a portion of your medical services, referred to as coinsurance. For example, many policies pay between 60% to 80% of your healthcare costs, while you cover the remaining 20% to 40%.
You have an annual out-of-pocket maximum that includes copayments, deductibles and coinsurance. Once you reach your out-of-pocket maximum, the insurance company pays 100% of your healthcare costs.
Consider the plan’s healthcare provider network. Whether an HMO or PPO, all health plans have an approved provider network. If you use healthcare service providers outside of the network, there is a good chance those charges won’t be covered by your policy.
Can the insurance company deny my claim?
No. With the health care reform law, individuals have the right to appeal a health insurance company’s claim denial. The first step in appealing a claim denial is to make an “internal appeal” through your health insurance company. An “internal appeal” is a formal request for your health insurance company to perform a full review of its original decision. Should your health insurance company maintain its claim denial even after the “internal appeal,” the health care reform law allows you to initiate an “external review,” in which you can have an independent third party either confirm or overturn your insurers’ decision.
Is the tax credit (premium subsidy) still available?
Yes. In fact, the subsidy has been enhanced by the Inflation Reduction Act of the Biden Administration. According to Kaiser, the subsidy will pay the full costs for a silver plan for consumers with income up to 150% of the federal poverty level (FPL) (originally this plan would have cost families at the same income level about 4% of our annual income). Note that having access to silver plan also drastically reduces copays and deductibles.
Do I need health insurance to avoid a tax penalty?
Currently, most people are not required to purchase health insurance. The ACA “shared responsibility payment” and the individual mandate has been eliminated by the Trump Administration for 2019 and beyond. However, some states have established their own individual mandates, so you still may be subject to your specific state tax penalty, if any.
Following is a list of the states, as of 2019, that have mandated residents purchase qualifying health insurance (which is similar to the federal essential health benefits), or face a tax penalty when they file their income taxes.
Updated in 2023…
California – The penalty for not having coverage the entire year will be at least $850 per adult and $426 per dependent child under 18 in the household. The penalty can also be calculated based on percentage; you could also be charged 2.5% of the gross income that exceeds the filing threshold, whichever is greater.
Massachusetts – the tax penalty amount varies depending on your income, age and family size, but note the maximum penalty can be no more than half the price of the lowest premium plan available on the Massachusetts healthcare marketplace.
New Jersey – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of annual income,. The penalty is capped at three times the adult penalty ($3,661), or the state average cost for a bronze-level plan, whichever is greater.
Rhode Island – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of income, or three times the adult penalty ($2,100), whichever is greater. The maximum tax penalty is based on the average bronze health plan premiums cost.
Vermont – Vermont requires residents to have qualifying health insurance, but currently, there is no cash penalty for non compliance.
Washington, D.C. – the tax penalty is $700 for adults and $350 for each child, with a maximum family penalty of 2.5% of income, or three times the adult penalty ($2,100), whichever is greater. The maximum tax penalty is based on the average bronze health plan premiums cost.
What if I miss health insurance open enrollment?
While the the Affordable Care Act no longer requires you to have health insurance, it does require carriers to only allow enrollment during an annual open enrollment period. Therefore, individuals can purchase individual insurance coverage on the Individual Market during the annual open enrollment of November 1st through December 15th of each year.
Special Enrollment: You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:
- change in legal marital status
- a change in the number of dependants
- a change in place of residence and the current carrier is not available
- significant cost or coverage change a change in coverage of a spouse or dependant
- a COBRA qualifying event
- legal judgements, decrees and orders
- entitlement to Medicare or Medicaid
*Some states have an extended open enrollment period, such as Pennsylvania, which runs from Nov 1st through Jan 15th. Check with your state for specific and accurate enrollment information.